Provider Demographics
NPI:1659430528
Name:YEROVI, LUIS A SR (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:YEROVI
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:33 MAEBELLE DR
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2216
Mailing Address - Country:US
Mailing Address - Phone:732-382-9717
Mailing Address - Fax:732-382-3728
Practice Address - Street 1:91 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1801
Practice Address - Country:US
Practice Address - Phone:973-344-7676
Practice Address - Fax:973-690-5109
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA02444000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ16143-04Medicaid
NJ16143-04Medicaid
NJ459518Medicare ID - Type Unspecified